What to expect, what you’ll need, etc.

Click here for the EDS specific document, and here for POTS.

Both templates can be customised to suit your situation.

You can find the NDIS information for practitioners here.

Click here.

This is focussed on Autism, however, the advice is still applicable for most scenarios.

Documents I typically request for reassessments (not all will be applicable):

• Reports from each provider, either as a progress report or letter of support with recommendations specific to that therapy (and others if applicable).
  It is helpful to have those providers ensure everything links to your approved disability, functional capacity, how these supports will allow you to manage your functional capacity, any progress made and references of studies to validate their recommendations.

• Impact Statements - from you, family, carers

• Letter of support from your support worker

• Progress report from Support Coordinator with recommendations - detailing progress made since plan implementation or previous plan, speaking on goals and progress of those goals. Detailing risks associated with inappropriate funding, targeting NDIS criteria (cost effective, related to disability etc)

• If additional/new diagnostic information, those reports

• Quotes for any assistive tech / consumables, and appropriate OT supporting evidence

Documents for review / 12 month check in:

• Provider progress reports / short letter of progress - be sure to discuss goals, functional capacity, therapy goals, risks associated if inaccessible

• Support Coordinator / PRC progress report (either self templated or NDIS template)

• Any updated / new diagnostic information

• GP, Paediatrician, other specialist letters of support (as applicable)

** Applicable for plans funded and approved for Autism, over the age of 25.
Even better if it comes from your own psychologist.

Dear NDIS Representative,

It is important to note that the Medicare Better Access initiative is designed to provide short-term, focused psychological strategies for individuals with mild to moderate mental health conditions. This includes treatment for anxiety disorders, depression, adjustment disorder, and post-traumatic stress disorder (PTSD). The Better Access initiative does not cover therapy sessions aimed at capacity building for individuals with neurodevelopmental disorders or disability-related challenges.

According to the Department of Health and Aged Care website, the Better Access initiative "gives Medicare rebates to help people with mild to moderate mental health conditions access care" from eligible allied health professionals, including psychologists.

The website states:

"The Better Access initiative aims to improve treatment and management of mental illness within the community. It is increasing community access to mental health professionals and team-based mental health care, with general practitioners encouraged to work more closely and collaboratively with psychiatrists, clinical psychologists, registered psychologists and appropriately trained social workers and occupational therapists."

Furthermore, while Medicare provides for the management of complex neurodevelopmental disorders, under a separate program of rebates. This program is only available for patients 25 years of age and under. As Client has aged out of this Medicare rebatable service, they are no longer eligible to access this support through Medicare.

Client 's therapy goals and the nature of our sessions are distinct from the treatment of mental health conditions under the Better Access scheme. Our work together centres around building Client 's capacity to understand and manage their neurodivergence, develop self-advocacy skills, and navigate challenges related to their disability supports and funding. These goals align with the NDIS's focus on capacity building and improving functional outcomes for participants. Client 's interventions are multidisciplinary. Medicare does not provide funding for multidisciplinary meetings required to coordinate Client 's care.

Furthermore, even if Medicare were suitable to cover the psychological service it is crucial to consider the financial impact of relying on Medicare-subsidised sessions for Client 's therapy. Medicare only partly covers psychology session fees, leaving a significant out-of-pocket expense for Client. Given their current financial situation, this additional cost would likely put Client at a substantial disadvantage and may prevent them from continuing their essential therapy sessions. This would be detrimental to their progress and capacity building goals.

I kindly request that the NDIS continue to fund Client 's therapy sessions in full, as they are essential to their capacity building and are not covered under the Medicare Better Access scheme or the Medicare rebatable service for complex neurodevelopmental disorders due to Client 's age. Requiring Client  to access Medicare-subsidised sessions for this purpose would be inappropriate and would not adequately meet their needs as an NDIS participant.

Please do not hesitate to contact me if you require any further information or clarification regarding Client 's therapy goals and the limitations of Medicare funding in this context.

Thank you for your understanding and support.

Reference: Department of Health and Aged Care. (2022). Better Access initiative. Australian Government. https://www.health.gov.au/initiatives-and-programs/better-access-initiative

(Shout out to Bo at Connex Relating for his help with this! Clinical Psychologist - Connex Relating Agency)